Lv Qianyu, Wu Qian, Yang Yingtian, Li Lanlan, Ye Xuejiao, Wang Shihan, Lv Yanfei, Wang Manshi, Li Yushan
Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
School of Management, Fudan University, Shanghai, China.
Front Cardiovasc Med. 2025 Jan 14;11:1444068. doi: 10.3389/fcvm.2024.1444068. eCollection 2024.
This network meta-analysis was to compare the efficacy of different drugs on cardiac function, renal function, and clinical outcomes in patients with acute heart failure (AHF) accompanied by renal dysfunction.
PubMed, EMBASE, Cochrane Library, and Web of Science were searched to screen all clinical trials of AHF between January 1st 2001 and March 31th 2024. The primary outcome measures were N-terminal pro-B type natriuretic peptide (NT-proBNP), B-type natriuretic peptide (BNP), glomerular filtration rate (GFR), blood urea nitrogen, serum creatinine, all-cause mortality within 60 days, and cardiovascular mortality.
After screening 30,697 citations, 13 studies (21,745 patients) were included, and drugs including nesiritide, dopamine, tolvaptan, levosimendan, dobutamine, furosemide, and spirolactone, and high dose of diuretics (HDD, furosemide, and spirolactone) were estimated. The results indicated that HDD had the best efficacy in reducing NT-proBNP levels. In detail, HDD notably reduced NT-proBNP levels compared to conventional treatment or placebo (PLC) [MD = -950.24; 95% CrI (-1,832.21, -64.12)]. Levosimendan significantly increased GFR levels compared to PLC [MD = 14.46; 95% CrI (3.88, 25.97)] and tolvaptan [MD = 13.83; 95% CrI (2.31, 25.33)]. No significant difference was found in 60-day all-cause mortality and cardiovascular mortality across drugs.
HDD showed the best efficacy in reducing NT-proBNP levels compared with dopamine and nesiritide, and levosimendan could significantly improve GFR levels, with no marked difference in the effect of various drugs on 60-day all-cause mortality. Hence, HDD and levosimendan may be optimal agents in the treatment of AHF with renal dysfunction.
PROSPERO, identifier (CRD42023454616).
本网络荟萃分析旨在比较不同药物对伴有肾功能不全的急性心力衰竭（AHF）患者心功能、肾功能及临床结局的疗效。
检索PubMed、EMBASE、Cochrane图书馆和Web of Science，以筛选2001年1月1日至2024年3月31日期间所有AHF的临床试验。主要结局指标为N末端B型利钠肽原（NT-proBNP）、B型利钠肽（BNP）、肾小球滤过率（GFR）、血尿素氮、血清肌酐、60天内全因死亡率和心血管死亡率。
在筛选30,697篇文献后，纳入了13项研究（21,745例患者），评估了包括奈西立肽、多巴胺、托伐普坦、左西孟旦、多巴酚丁胺、呋塞米、螺内酯以及高剂量利尿剂（HDD，呋塞米和螺内酯）在内的药物。结果表明，HDD在降低NT-proBNP水平方面疗效最佳。具体而言，与传统治疗或安慰剂（PLC）相比，HDD显著降低了NT-proBNP水平[MD = -950.24；95%可信区间（-1,832.21，-64.12）]。与PLC[MD = 14.46；95%可信区间（3.88，25.97）]和托伐普坦[MD = 13.83；95%可信区间（2.31，25.33）]相比，左西孟旦显著提高了GFR水平。各药物在60天全因死亡率和心血管死亡率方面未发现显著差异。
与多巴胺和奈西立肽相比，HDD在降低NT-proBNP水平方面疗效最佳，左西孟旦可显著提高GFR水平，各药物对60天全因死亡率的影响无明显差异。因此，HDD和左西孟旦可能是治疗伴有肾功能不全的AHF的最佳药物。
PROSPERO，标识符（CRD42023454616）。
